Cardiac angiosarcoma with the presence of mycobacterium tuberculosis complex genetic material

Abstract

Introduction: Primary cardiac angiosarcoma is a rare malignant tumour originates predominantly from the right side of the heart. Rapid clinical course and unfavourable outcome are expected. Among from several risk factors for thoracic angiosarcoma chronic post-tuberculosis pleurisy was postulated. Case report description: 38 year-old male with 3 months history of precordial pain and progressive fatigue was referred to the Department of Cardiomyopathies (DC). He had been diagnosed with acute pericarditis in another hospital a month before. Nonsteroidal anti-inflammatory drugs and heart failure treatment had improved the disease symptoms then. He reported one week hectic fever on admission to DC. A dull percussion note and reduced vesicular breath sounds over the basal field of the right lung were found. Inflammatory markers were elevated. Chest X-ray showed moderate right-sided pleural effusion and suggested a pericardial effusion. Moreover, echocardiogram revealed a solid mass close to the right atrium. Bloody fluid was obtained through pericardiocentesis, no atypical cells were found. Cardiac magnetic resonance and chest computed tomography suggested a malignant process of pericardium close to the right atrium and right ventricle. During on-pump cardiac surgery the tumour originating from the right atrium was removed. Focal involvement of right ventricle precluded a complete tumour resection. Angiosarcoma was identified in pathological examination. Though genetic material of Mycobacterium tuberculosis complex was present in the tumour tissue, no granulomas were found. Bacteriological culture of tissue was negative. Patient received doxorubicin-based chemotherapy with no satisfactory response. Due to numerous brain metastases he required palliative radiotherapy 3 months after the surgery. Discussion: We describe the first case of Mycobacterium tuberculosis complex genetic material presence in cardiac angiosarcoma tissue, according to our knowledge. We excluded active tuberculosis in our patient and referred him for chemotherapy. However it has been already reported, seeming improvement after anti-inflammatory treatment is not characteristic of angiosarcoma. It caused a delay in the correct diagnosis of described patient. Conclusions: Although primary cardiac tumours are extremely rare, they should be considered in differential diagnosis of pericardial fluid. Tuberculosis may be deliberated as a risk factor for cardiac angiosarcoma in further research.